Forms, Numbers, & Compliance Notifications

CONTACT NUMBERS

AFLAC CANCER CARE
1-800-99-AFLAC

ANTHEM MEDICAL
1-888-641-5224

ANTHEM DENTAL
1-888-641-5224

BOSTON MUTUAL WHOLE LIFE
1-800-669-2668

CHARD SNYDER
1-800-982-7715

HRI DENTAL
1-800-727-1444

Anthem.com Resources

Member Services                 1-844-720-0798
Dental Services                    1-866-641-7762
24/7 Nurseline                      1-888-279-5449
Pre Certification                    1-866-643-7087
Provider Services                 1-800-676-2583
Pharmacist Questions          1-800-824-0898
Coverage While Traveling    1-800-810-2583

FORMS AND RESOURCES

CANCER CARE

COMPLIANCE NOTIFICATIONS

EDUCATIONAL SUPPORT

FAMILY AND MEDICAL LEAVE ACT

FLEXIBLE SPENDING

HOLIDAY SCHEDULE

MEMBERSHIPS & DISCOUNTS

TOBACCO CESSATION PROGRAM (TCP)

VISION DENTAL

WELLNESS PROGRAM

WHOLE LIFE

REMOTE HYBRID POLICY AND APPLICATION

Cancer Care

• AFLAC APPLICATION

• AFLAC AUTHORIZATION TO OBTAIN INFORMATION

• AFLAC OPTION 1

• AFLAC OPTION 2

• AFLAC OPTION 3

• AFLAC SUITABILITY NOTICE

• VU ENROLLMENT FORM

Compliance Notifications

Educational Support

• TUITION BENEFIT FORM
   

Family and Medical Leave Act

• FMLA LEAVE REQUEST FORM
• FMLA HEALTH CERTIFICATION OF HEALTH CARE PROVIDER FORM

Flexible Spending

• CARRY OVER FEATURE
• FSA ENROLLMENT FORM
• FSA HC BENEFIT CARD
• FSA DEPENDENT CARE

Holiday Schedule

• VU HOLIDAY SCHEDULE

Memberships & Discounts

• EVANSVILLE TEACHERS FEDERAL CREDIT UNION

• VERIZON WIRELESS

• AT&T

• STUDENT RECREATION CENTER

• YMCA

  • YMCA RATES

  • YMCA MEMBERSHIP APPLICATION

  • YMCA PAYROLL DEDUCTION AGREEMENT

  • YMCA PAYROLL DEDUCTION FORM

Tobacco Cessation Program

• TOBACCO SURCHARGE

Vision Dental

• TRUHEARING DISCOUNT

• VSP ENROLLMENT FORM

• VSP SUMMARY OF BENEFITS

• PARAMOUNT DENTAL

• PARAMOUNT PLAN SUMMARY

• PARAMOUNT PRINTABLE APPLICATION & UPDATE FORM

Wellness Program

• STUDENT RECREATION CENTER

• EMPLOYEE WELLNESS PROGRAM

• GET FIT FLYER

Whole Life

• BOSTON MUTUAL BROCHURE

• BOSTON MUTUAL APPLICATION

Files:

2026 MEDICAL SUMMARY PPO 50

2026 MEDICAL SUMMARY PPO 75

2026 DENTAL SUMMARY

2026 DENTAL INSURANCE RATES

2026 MEDICAL INSURANCE RATES (UNDER 44.5K)

2026 MEDICAL INSURANCE RATES (OVER 44.5K)

ANTHEM HEALTH BENEFIT BOOK - ACTIVE WITH CLINIC ACCESS

ANTHEM HEALTH BENEFIT BOOK - ACTIVE WITHOUT CLINIC ACCESS

ANTHEM HEALTH BENEFIT BOOK - RETIREES

EMPLOYEE CHANGE FORM APPLICATION

INJURY/ILLNESS REPORT

PRESCRIPTION DRUG LIST

MXP RETAIL MAIL ORDER FORM

UNIFORM GLOSSARY

SUMMARY OF BENEFITS AND COVERAGE (SBC) 50

SUMMARY OF BENEFITS AND COVERAGE (SBC) 75

SUMMARY OF BENEFITS AND COVERAGE (SBC) RETIREE